No Heroic Measures: How Soon Is Too Soon to Stop?

Abstract

As cardiothoracic surgeons, we face many difficult problems in our professional lives, and base most decisions on clinical judgment developed and honed during many years of training and experience. Some decisions, however, are based on more than weighing scientific evidence and outcome probabilities, and they require value judgments on such matters as the desirability of alternative outcomes. Among the most difficult judgments we make are those that conflict with the views of the patient or the patient’s proxy (ie, agent appointed in advance by the patient) or surrogate (ie, agent authorized by law) decision maker. In cases of critical illness with low survival probability, discordant judgments about withdrawing life support are often based on perceived acceptability of the projected quantity and quality of life if the patient survives. The surgeon and the proxy or surrogate might find themselves on either of the opposing sides of the issue.